A prospective study of outcomes of emergency and elective surgeries for complicated colonic cancer

Colon cancer surgery following emergency presentation: effects on admission and stage-adjusted outcomes

“…Some papers have produced valid points that echo the intuitive assumptions many clinicians have on the topic, but many of the papers laying the foundation for this work are outdated as they are from the prescreening era: a 1995 study by Scott et al 13 gave some of the first evidence pointing at more advanced dis-ease and worse perioperative outcomes for emergency colorectal cancer patients, underlining the importance of screening initiatives, and a 1998 study by Porta et al 14 demonstrated shorter survival rates for patients admitted through the ED in a small set of 80 colon cancer patients. Finally, with data from the same decade, Biondo et al 15 confirmed differences in recurrence and survival in a prospective cohort (1996 to 1998), although not in all stages of disease.…”

“…A second issue that makes the findings of previous work hard to interpret specifically for colon cancer is the lack of differentiation that all but 2 14,15 of the discussed articles make between colon and rectal disease -an issue shared with many publications on the matter. [19][20][21] Malignancies of the colon and rectum have been shown to be quite different in tumor biology 22 and subsequent prognosis 23 and arguments to split both are a recurring issue in outcome studies.…”

Outcomes in the management of obstructive unresectable stage IV colorectal cancer

“…7 In this study, left sided obstructed tumours presented with distant metastasis in 57.9% of patients. It is also well known that emergency surgical treatment of colorectal obstruction deals with a high morbidity and mortality on the range of 46% and 19% respectively.…”

“…Avoiding anastomosis after resection in these patients was mainly explained by the technical difficulty of operating with a stent in place. Following our strategy for surgical treatment of colonic obstruction described elsewhere 7 , of the 12 patients who were resected an anastomosis was achieved in 9 patients (75%). Quality of life comparisons between stenting and palliative colostomy may not be as fair as between stenting and resection with primary anastomosis and remains an issue that needs further understanding.…”

“…Both synchronic metastasis and bowel obstruction are considered poor prognosis factors as well as high preoperative levels of CA 19.9, histological grade, extension of liver metastasis or peritoneal metastases. 2,5,6 Resection of the primary tumour has been claimed to improve survival 7,8 but it has also been suggested that adding a surgical aggression to palliative patients with high volume disease may lead to high morbidity and mortality. The American Society of Clinical Oncology (ASCO) does not recommend resection of stage IV CRC in asymptomatic patients unless an intention to cure strategy is planned or when at risk of obstruction.…”